Tuesday, June 12, 2012

Why do some doctors do so many tests after a failed IVF cycle ?

When an IVF cycle fails , many IVF specialists will run a panel of expensive tests, in order to find out “ why the cycle failed”. They often do this because of pressure from their patients , who want to know why the cycle failed. The honest answer is – We do not know, but few doctors have the guts to tell patients the truth. Patients want answers – and the easiest way of providing these is by running more tests , to see if we can uncover more problems . This seems like a perfectly logical and sensible approach, which is why patients who have failed IVF cycles will be subjected to a battery of expensive exotic tests in many clinics.

However , this is an extremely illogical approach. Not only are most of these tests very expensive , they are actually quite useless , because they provide very little useful information. A lot of these tests will be abnormal even in normal fertile couples , and do not give us any useful information. Doctors do them, simply because they need to pander to the patient’s insistence that something new be done, just because the first cycle has failed . Doctors run the tests to keep their patients happy - and to stop the patients from asking more questions.

Sadly, patients don’t want the truth – they want answers ( even if they are incorrect !) If the doctor tells them – “ We do not know why the cycle fails” , the doctor is worried that the patient may start doubting his expertise. This is why doctors are forced to manufacture “pseudo-answers” – and the more esoteric they are, the better ! Doctors have learned to position themselves as “experts”, in response to patient demand for omniscience from their physicians !

The reason why this is such an illogical approach is that if the tests were really useful, the doctor should have done them even before starting the first IVF cycle itself ! After all, , the patient and the doctor should want every IVF cycle to succeed – whether it’s the first or the second ! If the tests are useful , the identifying problems before the first cycle itself starts would allow the doctor to “treat” the abnormality, thus allowing the first cycle itself to succeed, rather than fail.

The fact of the matter is that there are very few tests which provide much useful information in an IVF cycle . This is why doing a number of expensive tests after a failed IVF cycle is extremely illogical and doesn't serve much purpose. These tests include immunological tests; tests for endometrial function ; and sperm DNA fragmentation tests. The reason the list is long just testifies to the fact that all of them are pretty useless.

So what is the solution? It’s important that doctors spend enough time counseling patients prior to the start of the IVF cycle, so that patients have realistic expectations of their chances of success. If this is done properly, patients will not go to pieces if the first cycle fails – and will be able to take the failure in their stride, rather than demand that the doctor provide them with answers. This is because they are now well-informed enough to realize that embryo implantation is a messy biological process over which we have very little control – and that it’s not possible for us to track the fate of the embryos after we have transferred them. Remember that human reproduction is an inefficient enterprise – whether it’s being done in the bedroom, or in the clinic !